This transcript has been edited for clarity.
Hi. I'm Art Caplan, at the Division of Medical Ethics at the NYU Grossman School of Medicine in New York City.
Much has been going on in the political arena. Something happened in England and Wales that perhaps escaped your attention, but probably not. There was a huge debate in Parliament on a bill, the Terminally Ill Adults (End of Life) Bill, which was introduced by a Labour MP, Kim Leadbeater, and proposed giving terminally ill people the right to choose to end their life.
It passed, and it was interesting because the debate over the bill was not one where the political opponents squared off. It was a place where people crossed party lines and took positions that were personal to them, based upon their own experience with relatives or loved ones who had died.
It was a surprise, I think, to many that England and Wales passed the legislation. It's not over. It has to go to their House of Lords and there are a few more steps, but I think most people I talk to in Britain say that this is going to happen.
The bill says that anybody over 18 who lives in England or Wales; has had a general practitioner assigned from the National Health Service for at least a year; is competent; and has expressed a clear, informed desire without any coercion to end their life due to terminal illness (meaning 6 months to live), if they express that twice, put it in writing, and satisfy two independent doctors as well as a high court judge, then they should have access to — after a short waiting period — medicines that they could take to end their life.
Some of you may be saying that sounds somewhat familiar, and it is. It is exactly the policy that many states in the US have adopted, some since the mid-1990s, to allow terminally ill people to end their own lives with the assistance of a prescription, if those very same conditions — more or less — are met.
The one difference between, say, Washington, Colorado, Oregon, New Jersey, or Hawaii — states that have all passed this and have had it on the books — is that there is a judicial signoff required in addition to the two doctors.
You might say the British approach is a little more conservative. The British approach is not what's going on in Europe and Canada, where they're not using a standard of terminal illness to be eligible. They're using a standard of whether the patient is suffering. That opens the door to many more people qualifying because you don't have to be dying. You just have to say, I'm in irremediable pain. I'm suffering.
That sets off a whole slew of controversies about how that is defined, whether that can be assessed, and whether conditions like anorexia fit into these categories of suffering that you can't fix. Shouldn't we try to help people with severe depression, not give them a suicide option, and on and on.
That's not what's going on in the US, and that's not what's going on in Britain. I support what took place in Britain. I think safeguards are in place and the restriction of who can do it is appropriate. I wanted to make a couple of points because there is experience and information on how things are going here.
Two simple points: There are really almost no instances of abuse in any of our states, where someone is being rushed off to choose dying when they're terminally ill because they're costing people money or they're too big a burden to the family. We would have heard about such cases. They would have been splashed all over the media. We don't get them.
In the states that have put these policies in place, there's been no effort in the legislature to change. There's been no disappointment about having these laws on the books. The idea that the disabled or the vulnerable might get hastened by relatives or somebody to choose death early, I just haven't seen it.
The other point is that very few people use this. Probably less than 1.5% of all deaths in America are associated with elective assistance in dying. That's because most people don't want to die early. They want to live as long as they can, get to the next birthday, get to a wedding or see it on Zoom, or enjoy another visit.
Many patients who are dying report that they like having the option of ending their lives as a parachute, that they could turn to something and salvage a bad situation, but they don't use it. It's not something that has grown in popularity. It's not something that people in the US, over more than a decade, have increasingly chosen.
People ask to have it available but they don't use it. That probably says enough about why England made the right choice.
I'm Art Caplan. Thanks for watching.
COMMENTARY
Ethicist Supports Assisted-Suicide Policies — With Safeguards
DISCLOSURES
| March 20, 2025This transcript has been edited for clarity.
Hi. I'm Art Caplan, at the Division of Medical Ethics at the NYU Grossman School of Medicine in New York City.
Much has been going on in the political arena. Something happened in England and Wales that perhaps escaped your attention, but probably not. There was a huge debate in Parliament on a bill, the Terminally Ill Adults (End of Life) Bill, which was introduced by a Labour MP, Kim Leadbeater, and proposed giving terminally ill people the right to choose to end their life.
It passed, and it was interesting because the debate over the bill was not one where the political opponents squared off. It was a place where people crossed party lines and took positions that were personal to them, based upon their own experience with relatives or loved ones who had died.
It was a surprise, I think, to many that England and Wales passed the legislation. It's not over. It has to go to their House of Lords and there are a few more steps, but I think most people I talk to in Britain say that this is going to happen.
The bill says that anybody over 18 who lives in England or Wales; has had a general practitioner assigned from the National Health Service for at least a year; is competent; and has expressed a clear, informed desire without any coercion to end their life due to terminal illness (meaning 6 months to live), if they express that twice, put it in writing, and satisfy two independent doctors as well as a high court judge, then they should have access to — after a short waiting period — medicines that they could take to end their life.
Some of you may be saying that sounds somewhat familiar, and it is. It is exactly the policy that many states in the US have adopted, some since the mid-1990s, to allow terminally ill people to end their own lives with the assistance of a prescription, if those very same conditions — more or less — are met.
The one difference between, say, Washington, Colorado, Oregon, New Jersey, or Hawaii — states that have all passed this and have had it on the books — is that there is a judicial signoff required in addition to the two doctors.
You might say the British approach is a little more conservative. The British approach is not what's going on in Europe and Canada, where they're not using a standard of terminal illness to be eligible. They're using a standard of whether the patient is suffering. That opens the door to many more people qualifying because you don't have to be dying. You just have to say, I'm in irremediable pain. I'm suffering.
That sets off a whole slew of controversies about how that is defined, whether that can be assessed, and whether conditions like anorexia fit into these categories of suffering that you can't fix. Shouldn't we try to help people with severe depression, not give them a suicide option, and on and on.
That's not what's going on in the US, and that's not what's going on in Britain. I support what took place in Britain. I think safeguards are in place and the restriction of who can do it is appropriate. I wanted to make a couple of points because there is experience and information on how things are going here.
Two simple points: There are really almost no instances of abuse in any of our states, where someone is being rushed off to choose dying when they're terminally ill because they're costing people money or they're too big a burden to the family. We would have heard about such cases. They would have been splashed all over the media. We don't get them.
In the states that have put these policies in place, there's been no effort in the legislature to change. There's been no disappointment about having these laws on the books. The idea that the disabled or the vulnerable might get hastened by relatives or somebody to choose death early, I just haven't seen it.
The other point is that very few people use this. Probably less than 1.5% of all deaths in America are associated with elective assistance in dying. That's because most people don't want to die early. They want to live as long as they can, get to the next birthday, get to a wedding or see it on Zoom, or enjoy another visit.
Many patients who are dying report that they like having the option of ending their lives as a parachute, that they could turn to something and salvage a bad situation, but they don't use it. It's not something that has grown in popularity. It's not something that people in the US, over more than a decade, have increasingly chosen.
People ask to have it available but they don't use it. That probably says enough about why England made the right choice.
I'm Art Caplan. Thanks for watching.
Any views expressed above are the author's own and do not necessarily reflect the views of WebMD or Medscape.
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